Times of India
01 June 2010
By Ajanta Chakraborty
Kolkata, India

If you thought cataract only struck the elderly, it’s time for an update. Children as young as three months and five years old are increasingly being detected with the eye ailment.

Some are born with it, while others develop it during the first few months of their lives. Some paediatric cataracts are inherited and others are related to metabolic or systemic abnormalities. In many cases, the cause is unknown.

However, cataract in children has lately caught the opthamologists’ attention. Some city doctors have even decided to hold medical camps especially to urge parents to go for cataract surgery of their children. Susrut Eye Foundation, for instance, has arranged a special such camp on Friday.

“Life’s extremely difficult for such children. First, they can’t even explain what is the problem with their eyes. If they are old enough to do so, parents tend to ignore their complaint. Even doctors may ignore the disease as mere vision problem,”said R C Pal, secretary of Susrut.

The eye foundation, which is involved in the Centre’s Sarva Shiksha Abhiyan and is responsible for eye treatment of children across the districts, has found cataract to be the most common paediatric vision disorder. Opthalmologist Souvik Banerjee of Ramakrishna Mission Seva Pratisthan, too, said they keep getting cases of children with cataract.

Doctors warned that the syndromes should not be ignored. Cataract in a child may interfere with visual development. If the cataract is present in just one eye, the child will prefer the normal eye and ignore the eye with the cataract, leading to the development of amblyopia (lazy eye) and strabismus (wandering eye).

In the older children, cataracts are often related to injuries or ocular inflammation related to juvenile rheumatoid arthritis. When a severe cataract occurs, prompt surgery and rehabilitation are required to maximize visual development.

But what causes cataract at such an early age?“Sometimes it is congenital,”said Banerjee.“Sometimes the cataract is caused by trauma or blunt injury. In other cases, child cataract is attributed to TORCH.”

Torch is an acronym for Toxoplasmosis, Other infections namely hepatitis B, Rubella, Cytomegalovirus and Herpes simplex virus. TORCH infections are important primarily because they can be transmitted to the unborn child from the mother. If a woman is exposed to any of these infections during the first five months of pregnancy, the baby may die in the womb or suffer serious complications, including cataract.

Unlike adults, cataract surgery in children requires general anaesthesia. Microsurgical techniques are used, allowing almost complete removal of the cataract that decreases the chance of its recurrence. Following surgery, infants less than 12 weeks of age are kept in the hospital overnight for observation.

Don’t ignore a vision problem
What is cataract?
A cataract is a clouding of the lens inside the eye. The lens sits behind the iris and helps focus the light rays that enter the eye. If the lens is cloudy, vision is reduced because light cannot reach the retina

What causes cataract in kids?

• Some are born with cataract
• Caused later by trauma or blunt injury
• Hereditary factors
• TORCH (Toxoplasmosis, Other infections namely hepatitis B, Rubella, Cytomegalovirus and Herpes simplex virus) infections
• In many cases, the cause is unknown

Treating paediatric cataract

• The treatment of cataract varies, depending on how cloudy the lens is. If vision loss is only slight, no treatment is necessary. Usually the cloudy lens must be removed before vision can improve
• Children undergoing surgery are given general anaesthetic. The abnormal lens is then removed through a small incision in the eye. Generally the child feels little or no pain after the operation, and is able to go home a few hours later
• Infants less than 12 weeks of age are kept in the hospital overnight for observation
• The child will need to be examined by the ophthalmologist several times over the following weeks. A protective eye shield is worn for a while and eye drops are given several times a day

Symptoms

• White or grey pupil
• Poor vision, not being able to recognise mother (normally recognises by 2 months of age), not responding to visual stimuli
• The eye with cataract may wander out of line causing squint (strabismus), or may show a jiggling movement (nystagmus)

Early treatment is important
Cataract prevents normal development of the eye, especially if it is only in one eye. This condition is known as amblyopia or lazy eye. Therefore it is important to treat cataract at the earliest